A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

Abstract

This study aimed to present a simplified and safe method to reposition the bone segment with easy identification and removing bone interference using a robot arm and image-guided navigation and to assess the accuracy for maxillary orthognathic surgery on phantom skulls. A surgical system consists of a robot arm with specialized end-effector, and image-guided navigation including the optical tracking system. The end-effector was designed to reflect the surgical procedures including identification and removal of bone interference and repositioning of the bone segment. To evaluate the handling and accuracy of this system, 10 phantom-based experiments were conducted according to four surgical plans. Mean absolute deviations at the upper central incisor were 0.10 ± 0.15 mm medio-laterally, 0.05 ± 0.07 mm antero-posteriorly, and 0.12 ± 0.15 mm supero-inferiorly. There was no significant difference in deviations between anterior and posterior regions of the maxilla. The mean root mean square deviation was 0.18 ± 0.16 mm, and ranged from 0.05 mm to 0.54 mm. The robot arm and image-guided navigation assisted surgical system would be helpful to manage bone interferences and reposition bone segments with improved accuracy. Though further technological advances are necessary, this study may provide a basis for developing clinically applicable robot assisted system for orthognathic surgery.

Keywords

• orthognathic surgery
• maxillary repositioning
• robot arm assisted surgery
• navigation surgery
• end-effector